Jan012011

Santiago Atitlan, Guatemala

I have spent the last three weeks working in the Hospitalito in Santiago Atitlan, Guatemala. Santiago Atitlan is a city of 50,000 people, located on beautiful Lake Atitlan, surrounded by three towering volcanoes. The hospital consists of a four bed ED, two labor and delivery rooms with two beds in each, three inpatient rooms, and an operating room. The two upper levels are currently under construction, but will greatly increase the capacity of the hospital. The staff consists of mainly volunteer physicians and local nurses and technicians. The main language spoken by the patients is Tz'utujil, which is then translated by the nurses to Spanish for the physicians. Patients came to the hospital from towns all around the lake and surrounding area. They often arrived via Tuc-Tuc (motorcycle-taxi), but sometimes walked, were carried by family members, or arrived by Bomberos (volunteer firefighters without medical training or resources).

Resources in the hospital were limited, thus the methods diagnosis and treatment of patients varied greatly from what I have become used to at Vanderbilt. Most of the medication and supplies for the hospital are donated by volunteers when they come to work, thus there were times when items that were needed were not available. There are no ventilators or cardiac monitors, mainly because there is no one there to maintain this type of equipment. Laboratory studies are only available Monday through Friday 8-12am and 2-4pm. Imaging is limited to occasional x-rays and a later model ultrasound. There were several OB physicians available at all times to manage obstetrical issues, and a general surgeon every two weeks. Patients requiring a higher level of care or a specialist have to be transferred to one of the national hospitals in Solala or Guatemala City, 2 or 3 hours away by ambulance. The staff did everything possible to conserve available resources, such as cleaning and reusing endotracheal tube stylets (there was only 1 in the hospital), making their own cotton balls, and using suction cup EKG leads rather than disposable stickers for the leads. Adjusting to the differences in practice was challenging for me. In our medical culture, labs and imaging guide treatment. Suddenly, I was unable to use these tools in my medical decision making process. I was also not able to tell patients to go see their doctor or a specialist for follow up; most of them did not have the money to see another doctor or undergo further testing.

I mainly worked in the Emergency Department (ED), but also spent a few days working in the outpatient clinic. Each day one person would be "Turno", which meant they were in charge of the ED as well as all of the patients admitted to the hospital (post-op patients, post partum patients, neonates, and medical patients). Turno is a 24 hour shift. The majority of the patients would arrive between 7am and 9pm, the hours that the Tuc-Tucs run. Those that came outside these hours were generally very ill, as they would have to find private (and expensive) means of transportation. On each of my 24-hour shifts, I saw about 15 patients in the ED. Many of these patients had problems such as vomiting and diarrhea, sprained ankles, cough, and lacerations. A few patient encounters were remarkable, I will discuss them below.